Citation Nr: 22044536 Decision Date: 08/04/22 Archive Date: 08/04/22 DOCKET NO. 09-04 112 DATE: August 4, 2022 REMANDED Entitlement to service connection for psoriatic arthritis, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to April 1972, to include combat service in the Republic of Vietnam. The Veteran is highly decorated, having received the National Defense Service Medal, the Vietnam Service Medal, the Combat Infantryman Badge, and the Vietnam Campaign Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified with his spouse at a February 2011 Board hearing. A transcript of this hearing has been associated with the record. In July 2017, the Veteran was informed that the Veterans Law Judge (VLJ) who presided over the hearing was no longer with the Board, and he was given the opportunity to request another hearing. The Veteran was notified that if he did not provide a response in 30 days, it would be assumed that he did not want another hearing. The Veteran did not respond to the letter; therefore, the Board will proceed with adjudication of the Veteran's claim. In September 2017 the Board denied the Veteran's claim for service connection for psoriatic arthritis. The Veteran appealed the Board's September 2017 decision to the U.S. Court of Appeals for Veterans Claims (Court). In a November 2018 memorandum decision, the Court vacated the Board's denial of service connection for psoriatic arthritis and remanded the issue to the Board. The Board then remanded the issue for additional development in August 2019, October 2020, March 2021, and September 2021 for additional development. As discussed below, there has not been substantial compliance with the most recent remand instructions, so this matter must be remanded again. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for psoriatic arthritis, to include as secondary to service-connected PTSD, is remanded. The Veteran seeks service connection for psoriatic arthritis, to include as secondary to service-connected PTSD. The Veteran is currently service-connected for psoriasis, PTSD, right knee degenerative arthritis, left hand degenerative arthritis, and degenerative arthritis of the back. The Board's September 2021 remand instructed the RO to obtain a VA examination that opined whether the Veteran presents symptoms of psoriatic arthritis that are distinguishable from his currently service-connected conditions. The March 2022 VA examiner did not provide a medical opinion on this matter. Additionally, she opined that the Veteran's psoriatic arthritis was less likely than not due to his service and did not discuss the Veteran's February 2011 Board testimony that his psoriatic arthritis began during service and has continued to progress, and she stated that he was not service-connected for psoriasis, which is incorrect. Furthermore, The March 2022 VA examiner opined that the Veteran's psoriatic arthritis was less likely than not proximately due to his service-connected PTSD , however she neglected to address all of the medical evidence the Veteran submitted indicating that PTSD can cause/aggravate psoriatic arthritis, including multiple medical articles and the Veteran's February 2021 VA treatment records containing an opinion by Dr. S.Z. which indicates that the Veteran had been treated for many years for psoriasis and psoriatic arthritis, and the history of these diseases shows the severity of the illness is related to psychological illnesses, and the Veteran has PTSD, which makes his problem very hard to treat. The VA examiner also did not address the Veteran's testimony from his February 2011 Board hearing that when he is stressed and his PTSD is worked up, his psoriatic arthritis becomes enflamed. While the RO took steps to obtain VA examinations and medical opinions on the Veteran's behalf, it did not ensure that the opinions were adequate for the purposes of the determinations being made. See Barr v. Nicholson, 21 Vet. App. 303, 311. The matter is REMANDED for the following actions: 1. Schedule the Veteran for a new VA examination with a an appropriately qualified physician (M.D.), who has not previously examined the Veteran, to address the nature and etiology of the Veteran's psoriatic arthritis. The examiner must review the claims file in its entirety and the review should be noted in the examination report. Thereafter, the examiner is asked to provide a fully-articulated medical opinion with respect to the following: (a.) Is the full scope of the Veteran's skin and joint symptoms contemplated by his current awards of service connection (the Veteran is service-connected for psoriasis, right knee degenerative arthritis, left hand degenerative arthritis, and degenerative arthritis of the back), or does his psoriatic arthritis present with distinguishable symptoms which are not addressed by his current awards of service connection? If the Veteran presents with separately distinguishable symptoms of psoriatic arthritis, the examiner is asked to explicitly identify those symptoms and the affected body parts. (b.) Only if the Veteran presents with separately distinguishable symptoms of psoriatic arthritis, provide an opinion whether the Veteran's psoriatic arthritis began during active service, was incurred in or caused by his service, or is otherwise related to service? (c.) Only if the Veteran presents with separately distinguishable symptoms of psoriatic arthritis, provide an opinion whether the Veteran's psoriatic arthritis was caused by his service-connected PTSD or whether his psoriatic arthritis was aggravated by his service-connected PTSD? This is a 2 part question as to cause and aggravation. When providing the above medical opinions, the VA examiner must address (1) the Veteran's February 2011 Board testimony indicating that his symptoms began during service in Vietnam and have persisted since that time and that when he is stressed and his PTSD is worked up, his psoriatic arthritis becomes enflamed; (2) the Veteran's February 2021 VA treatment records containing an opinion by Dr. S.Z. which indicates that the Veteran had been treated for many years for psoriasis and psoriatic arthritis, and the history of these diseases shows the severity of the illness is related to psychological illnesses, and the Veteran has PTSD, which makes his problem very hard to treat; and (3) The medical articles the Veteran has submitted regarding the connection between PTSD and psoriatic arthritis (listed in his April 2019 brief, March 2021 brief, and July 2022 brief). The examiner is advised that the Veteran is competent to report his medical history and must be considered and weighed in making the determination requested above. The examiner must provide a complete rationale for any opinion expressed. If the examiner is unable to provide an opinion without resorting to speculation, he or she should fully explain why that is so. (Continued on the next page) The Board emphasizes that it is not determining whether or not the Veteran's statements that his psoriatic arthritis began during service and that his psoriatic arthritis was aggravated by his service-connected PTSD are credible at this time, as the additional development set forth in the directives below could impact that determination. Although the Board is requesting medical opinions regarding the Veteran's psoriatic arthritis, this is for thoroughness and not based on a finding that the Veteran's psoriatic arthritis began during service or that the Veteran's psoriatic arthritis was aggravated by his service-connected PTSD. 2. Thereafter, review the requested VA medical examinations and opinions report to ensure responsiveness and compliance with the directives of this remand; implement corrective procedures as needed. Compliance with the Board's remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ahuva D. Sunshine The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.